Provider Demographics
NPI:1093429797
Name:HARDIE, DAWSON MACRAE (PTA)
Entity Type:Individual
Prefix:MR
First Name:DAWSON
Middle Name:MACRAE
Last Name:HARDIE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BOLLENBECKER DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9306
Mailing Address - Country:US
Mailing Address - Phone:704-787-3216
Mailing Address - Fax:
Practice Address - Street 1:19460 OLD JETTON RD STE 202
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6763
Practice Address - Country:US
Practice Address - Phone:704-255-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant